Phantom limb pain among veterans
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Phantom limb pain among veterans
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[ID] => 558947
[post_author] => 12815
[post_date] => 2024-12-26 11:00:34
[post_date_gmt] => 2024-12-26 16:00:34
[post_content] => Practice Passage (Question 1-5)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Many veterans return from combat having sustained wounds that make it necessary for their limbs to be amputated. Though the surgery removes the immediate health risks associated with a severely wounded limb, it can also bring about an extremely painful experience called phantom limb pain. The origins of phantom limb pain are not well understood. Some theories propose that nerves are left behind at the amputation site, and that the brain misrepresents the information to include the entire leg. Another theory proposes that a reorganization of the somatosensory cortex causes the brain to produce sensations in the amputated limbs, though amputations that occur in younger individuals usually lack phantom limb pain.
Phantom limb pain can cause severe discomfort for the patient - some individuals experience intense episodes of momentary debilitating pain, while others experience continuous pain. Because pain-relieving medications and physical therapy do not always improve symptoms, patients are forced to over-medicate or seek alternative therapies. In military populations there has been increased interest in complementary and alternative medicine, especially auricular acupuncture for pain management.
Amelie is a 24 year old female military amputee who experiences chronic phantom limb pain. She typically rates her pain intensity as 5/10 during the day and 8/10 in the evening. In an attempt to manage her pain she takes morphine and oxycodone as needed and attends regular physical therapy sessions. However, her symptoms have not improved during the last six months she has been in treatment. Her doctor suggests auricular acupuncture as a potential treatment plan. The following excerpt is from Amelie’s patient notes:
“Initial assessment resulted in an overall pain rating of 6/10. Auricular acupuncture was performed on the left ear with an ear needle, inserted onto the cingulate gyrus point (one of the standard points for military acupuncture). After 60 seconds the patient rated the pain as a 2/10. She returned the next day for a follow-up session, this time reporting an overall pain rating of 4/10. After 90 seconds the patient rated the pain as a 0/10.”
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[question] => Which of the following is least likely to be associated with Amelie’s phantom limb pain?
[value] => Array
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[answer] => 2
[description] => Reason for the Correct Answer:
Glutamate is associated with mild pain.
Substance P is associated with strong pain.
GABA may potentiate morphine.
Epinephrine is more directly linked to immediate danger, not chronic pain.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Glutamate
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[each_answer] => B. Epinephrine
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[each_answer] => C. Substance P
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[3] => Array
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[each_answer] => D. GABA
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[1] => Array
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[quiz_unique_key] => 3873426850
[question] => Which of the following terms best describes Amelie’s use of acupuncture to treat her pain?
[value] => Array
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[answer] => 1
[description] => Reason for the Correct Answer:
Positive refers to the addition of a stimulus.
Negative refers to the removal of a stimulus.
Reinforcement refers to an increase in behavior.
Punishment refers to a decrease in behavior.
Amelie uses acupuncture to remove her pain. Because acupuncture removed her pain, she is more likely to seek it out again in the future. This is negative reinforcement.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Negative reinforcement
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[each_answer] => B. Positive reinforcement
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[each_answer] => C. Positive punishment
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[each_answer] => D. Negative punishment
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[2] => Array
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[quiz_unique_key] => 83407773
[question] => Which of the following brain areas registers which part of Amelie’s body is in pain and how intense her pain is?
[value] => Array
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[answer] => 3
[description] => Reason for the Correct Answer:
The anterior cingulate cortex is involved in registering Amelie’s physical and emotional feelings.
The thalamus receives pain signals and relays them to other parts of the brain
The periaqueductal gray mediates Amelie’s pain perception.
The somatosensory cortex registers what part of Amelie’s body is in pain and how intense that pain is.
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[each_answer] => A. Periaqueductal gray
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[each_answer] => B. Anterior cingulate cortex
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[each_answer] => C. Somatosensory cortex
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[each_answer] => D. Thalamus
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[quiz_unique_key] => 2261298308
[question] => Somatosensation is the ability to perceive sensations through the body surface. Which of the following statements is LEAST accurate regarding somatosensation?
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[answer] => 4
[description] => Reason for the Correct Answer:
Somatosensation relies on specialized nerve cells in the peripheral nervous system to relay information to the central nervous system.
The sensory homunculus in the brain specializes in interpreting and receiving sensory information from the rest of the body. It does not rely on the motor cortex in order to function.
Somatosensation relies on sensory nerves in the peripheral nervous system and the somatosensory cortex in the central nervous system, not on the motor cortex.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Mechanoception works in conjunction with proprioception to produce the sensation of our body’s position in space.
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[1] => Array
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[each_answer] => B. Nociception and thermoception utilize similar receptors in response to environmental stimuli.
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[each_answer] => C. Mechanoception, thermoception, nociception and proprioception are categories within somatosensation.
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[each_answer] => D. Somatosensation relies on the sensory and motor cortex to produce sensation.
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[quiz_unique_key] => 4015992898
[question] => Which of the following best describes what Amelie’s doctor tested by adding acupuncture to Amelie’s treatment?
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[answer] => 3
[description] => Reason for the Correct Answer:
Affinity is the ability of a drug to bind to a receptor.
Potency is the amount of a drug required to produce an effect.
Efficacy is the ability of a treatment to work in a lab setting.
Effectiveness is the ability of a treatment to work in a clinical setting. Amelie’s doctor tested the effectiveness of acupuncture in treating Amelie’s pain.
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[each_answer] => A. He tested acupuncture’s efficacy.
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[1] => Array
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[each_answer] => B. He tested acupuncture’s potency.
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[2] => Array
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[each_answer] => C. He tested acupuncture’s effectiveness.
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[each_answer] => D. He tested acupuncture’s affinity.
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[558947|1] => B
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[558947|5] => C
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